Russ Reina: Moments in the Death of a Flesh Mechanic

Russ Reina runs one of my “sister blogs” on the EMS Blogs network, EMS Outside Agitator. Although no longer working in EMS, he spent over a decade as a medic, way back in ’70s when the paramedic concept was first being introduced in the US; he later became involved with various other things including writing a film, working with Native American healing arts, and a book — Moments in the Death of a Flesh Mechanic: a Healer’s Rebirth. More recently he’s become active in the online EMS community via his blog, forums (he’s a moderator over at EMTLife.com), and similar venues.

Some time ago, Russ sent me a free copy of his book in exchange for my honest review. I read it, and enjoyed it, but it’s been sitting on my shelf since, because I haven’t been sure what to say about it.

To start with, let’s mention the elephant in the room. The stuff Russ talks about makes people uncomfortable. To be sure, he’s walked the walk, spending more hours on the road than many of us, and doing it in a time and place where that meant wielding tremendous responsibility in patient care. It’s hard to argue that he was a skilled and competent medic in his day, the kind of guy you’d be glad to have on scene or sitting beside you in the cab. But since then, he’s gone down a different road, and done a lot of… other stuff.

Tending fires in sweatlodges. Reiki. Personal growth and healing. If you click through his personal website, your first reaction is probably “… huh.” For the typical EMSer this is not really our wheelhouse, and at best, it places Russ firmly in the realm of alternative viewpoints. At worst it puts him in the same cart as the other EMS goofballs who do their job but are universally considered space cadets. (Admittedly this is a large cart, but still, it’s not great company.)

I confess that I share some of this attitude. I’m a simple, concrete guy at heart. But I also think that the things Russ talks about, and forces us to think about, are important — and that the reason we’re uncomfortable with them is the reason that we need to have that conversation.

The basic aim of his book is to weave together the calls he ran, the patients he sat beside, the lives and the deaths he saw, and look for the common threads. Not in the patients, but in him. As a paramedic, what was his role? When you take a step back from this job, when you stop for a moment and consider what it’s all about, what’s really going on?

If we’re diligent, and competent providers, we spend a great deal of time trying to improve the quality of our work: our knowledge base, our hands-on skills, our understanding of medicine and the human body — the how. But very little attention is ever given to the why. Why do we do this? It’s easy to be cynical — “well, the schedules are good, you get to cut people’s clothes off, and I was too dumb for anything else.” We’re professional cynics, and the job tends to beat the mushy stuff out of us. But although we rarely admit it, most of us did choose this job for real, human reasons. Something about helping people.

So we show up at the door wanting to help people. Then, usually a couple years later, most of us leave EMS to become nurses or electricians or vacuum cleaner repairmen. What happened between point A and point B?

You can call it burn-out, you can call it low morale. You can blame low pay and a “revolving door” culture and a million other things, most of which are valid and true. But the fact remains that even though people are coming to EMS with the right intentions, most of them aren’t surviving here for long, and of the ones who do stick around, many are empty shells, long since stripped of any human connection they once sought. This is an ill system. It’s not dying, we’re not end-stage, but we are not healthy or happy: the methods, mindsets, attitudes, and overall “immune system” necessary to keep us all going, to maintain our ideal homeostasis, is missing. Individually and collectively, as time passes we move down rather than up. Some rare individuals do find solid grounding and manage to put in 20 years as fully-functional people as well as caregivers, but they are the exception, and they do it by developing these tools on their own.

It’s not about competence. Many of our “walking wounded” are competent clinicians, adequate or even excellent technicians. Russ calls them flesh mechanics. We master the skills of of patching holes, adjusting rhythms, replacing fluids, and generally repairing the broken parts of the human body, all without ever acknowledging the people inside those bodies. To some extent, of course, this is an essential part of the job — it’s the M in EMS, it’s why we’re called to the scene. We ought to try and be excellent mechanics so we can save the most lives and mend the most harm. But this whole process is entirely separate and distinct from the motivations that brought us to the job to begin with. There’s a fundamental difference between tending to a car and tending to a person, and when we successfully manage to eradicate the human element, we quickly find ourselves unsatisfied and burned-out with our work. (It’s not like we’re getting rich doing it, or otherwise being externally rewarded.) Russ’s own journey of transitioning from a pure flesh mechanic back into someone who worked with people is the focus of his book.

Why do we do it? There are dozens of reasons you might pick. Some folks like to work and play at the boundaries, the liminal spaces between life and death. Some just really like meeting the people. Some, like Russ, have a more spiritual approach. Some find meaning from the teachings of traditional religion.

As for myself, I hate death, and suffering, and I want to guard people from it. And I think that I probably get an ego boost from fighting for the weak, and certainly from uncovering an interesting diagnosis. But most of all — and it’s the mindset I advocate for on this site — I simply adopt a deontological outlook: I believe that when we take a patient into our care, we assume a duty to do everything possible on their behalf. Not the duty to weigh the pros and cons, not to judge their need or worthiness, but simply to do it. Everyone deserves at least that.

But you might disagree. And that’s the key: many of us will disagree on how to handle the “why.” Unquestionably, I disagree with many of Russ’s views, or simply find them alien. However, I still think that it’s absolutely essential that we each find some meaning. There must be some human purpose to our work or we will not be happy, and eventually, we will not do it anymore. That’s the secret that Russ was able to uncover after enough years on the job and enough years away from it. Dozens of answers to the question are acceptable, but we at least have to ask the question; we do have to think about these things and not brush them aside. We have to operate on this level or we will not survive in the long run. Spirituality may or may not underly EMS as you understand it. But people — not just patients, not just broken machines — are unavoidably central to practicing medicine. You can do the job without that human connection, without the “why,” but it’s like showering with your raincoat on. You can’t feel it, and you won’t do a good job, and eventually you’ll give up and stop trying.

So to make a long story short, I think the task Russ has undertaken as an “agitator” is a tough one, and he won’t win many fans. Although he often clashes with the Rogue Medic, their jobs are not dissimilar; one is an continual gadfly working to force us toward better evidence-based medicine, and the other is a continual gadfly working to force us toward a healthier understanding of our job. I wouldn’t want to be either one. But I’m glad they’re here, because I also don’t want to watch good people being wasted in the cauldron of cynicism and pointlessness that is much of EMS today.

In any case, I do recommend his book. It’s an enjoyable read, well-written, with plenty of the entertaining stories that all veteran medics collect and that make the best EMS blogs and literature such good reads. It’s also a rare view of the early, Johnny-and-Roy days of paramedicine, and it’s fascinating to see what’s changed over the years and what hasn’t.

But mostly, I think it’s worth reading because Russ’s crusade really does have a vital purpose. If I have a quibble, other than the fact that his unorthodox background may turn many readers away from his message (although fairly little of that is present in the book), it’s that despite raising awareness to the problem, Russ is relatively silent as its to solutions. Of course, this may be the nature of the beast, where each of us needs to find his own answers. But on the large scale, I doubt the endemic disease of EMS will be cured in this way.

The only thing I might add is my agenda. What I want to accomplish is very simple; I want to make more room for such discussions to occur. But it’s not about talk…that’s only the first step.

I’m encouraged by such discussions going on in on-line forums like EMTlife.com (Full disclosure, I’m a Community Leader there but I– usually!– only add to discussions already going on.), AND my prayer is that this kind of support will be able to happen more and more in-person, peer to peer.

The reason EMS is not a true profession after some 40+ years is that too many good people fade away before they have a chance to truly commit to MAKING it a profession. To those of us remaining in the field, they fade away, but in reality it’s all about very personal burnouts. Since they don’t talk about it neither do we.

But what if we ALL started talking about this stuff as if it mattered?

I think if EMS is to become a profession, first we have to save ourselves. That’s why I spent 15 years working on the book. That’s why I’ve been active in on-line EMS Forums since 2005.

The book can be bought through my publisher, at http://www.russreina.com and is available from Amazon and the other on-line Biggies.

If you are looking for a gift for a new or old EMS provider, I suggest:
Moments in the Death of a Flesh Mechanic … a healer’s rebirth
By Russ Reina.

This book gives a very realistic and insightful account on the topics not spoken about in the classroom or when trying to impress by regaling an audience with life and death exploits, but are very real.

At one point in an EMS career whether just passing through EMS or as a life-long pursuit, EMS persons will have to come to terms with the mental and emotional impact of regularly being around human suffering that those not involved can hardly imagine.

After reading the manuscript and ultimately the book, I found myself identifying with many of the topics. Many times thinking “I did that” or “I had almost exactly the same experience.”

Additionally, the book gives a realistic first hand retelling of the birth and early progress of US EMS. If you know where you have been, it is easier to plot where you are going. Some things also have never changed.

If you are planning to get into EMS, having the knowledge Russ shares before you start is undoubtedly going to give you a realistic perspective of what to expect, both good and bad, as well as opening thoughts and encouraging communication about the elephant in the room most pretend does not exist.

I do not receive any benefit for my opinions on this book, monetary or otherwise, other than the perspective it brings. Were it up to me, I would make it mandatory reading for all providers. Absent that ability, all I can do is bring it to your attention.

The benefit of the knowledge it brings will last longer and be more valuable (What is the price you would put on your sanity or preserving your passion for your chosen career?) than any trinket you can purchase this or any other season. It will also probably cost a lot less too.